Provider Demographics
NPI:1679859300
Name:ROZEMA, ASHLEY DANELLE (PA)
Entity Type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:DANELLE
Last Name:ROZEMA
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Gender:F
Credentials:PA
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:CB 8072
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-362-9123
Mailing Address - Fax:314-747-4876
Practice Address - Street 1:1 BARNES JEWISH HOSPITAL PLZ
Practice Address - Street 2:DEPT EMERGENCY MED
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1003
Practice Address - Country:US
Practice Address - Phone:314-362-9123
Practice Address - Fax:314-362-0478
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2024-04-05
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Provider Licenses
StateLicense IDTaxonomies
MI5601008140363A00000X
MO2019022166363A00000X
363AM0700X
NY014935-1363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO220080922Medicaid